Prolonged Response of Meningeal Carcinomatosis from Non-small Cell Lung Cancer to Salvage Intrathecal Etoposide Subsequent to Failure of First-Line Methotrexate: A Case Report and Literature Review
Unusual clinical course, Unusual setting of medical care, Unexpected drug reaction , Educational Purpose (only if useful for a systematic review or synthesis)
Min Jae Park
Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea
Am J Case Rep 2015; 16:224-227
As the incidence of meningeal carcinomatosis (MC) in non-small cell lung cancer (NSCLC) patients has been increasing, MC has recently become an important clinical problem in the management of NSCLC. However, development of new treatments is lacking and a standard treatment guideline is not yet available. Research on salvage intrathecal chemotherapy after failure of first-line treatment for NSCLC patients with MC has rarely been reported in the literature. Here, we report the case of an NSCLC patient with MC who showed durable response to salvage intrathecal etoposide subsequent to failure of first-line methotrexate.
CASE REPORT: A 58-year-old Asian man with lung adenocarcinoma with bone metastasis presented gait disturbance, diplopia, and progressively increasing headache. The diagnosis of MC was made by brain magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) cytology. After MC progression was suspected during the first-line treatment of intrathecal MTx, intrathecal etoposide was used as a salvage treatment. Brain MRI performed after 2 months of the treatment demonstrated disappearance of enhancing lesions along the ependymal lining of the lateral ventricles. His clinical status markedly improved from Eastern Cooperative Oncology Group performance status of 4 to 2. Stable neurologic status was maintained and CSF cytology remained negative while weekly injection of etoposide was continued for 19 weeks. However, hepatic metastatic lesions persistently progressed despite systemic palliative chemotherapy and the patient died of the disease.
CONCLUSIONS: To our knowledge, this is the first case report in which intrathecal etoposide was successfully used to treat MC from NSCLC after failure of MTx. This case report might provide preliminary evidence of the feasibility of intrathecal etoposide as salvage intrathecal chemotherapy (ITC). Further clinical trials including larger numbers of patients are necessary to evaluate the role of this ITC regimen for NSCLC patients with MC.
Keywords: Carcinoma, Non-Small-Cell Lung - drug therapy, Antineoplastic Agents, Phytogenic - administration & dosage, Dose-Response Relationship, Drug, Etoposide - administration & dosage, Humans, Immunosuppressive Agents - therapeutic use, Injections, Spinal, Lung Neoplasms - drug therapy, Male, Meningeal Carcinomatosis - drug therapy, Methotrexate - therapeutic use, Middle Aged, Neoplasms, Multiple Primary, Treatment Failure